Medical Tourism and Quality Measures

Here is an article I wrote on quality measures for medical tourism

Medical Tourism and Quality Measures

Medical Tourism or the exportation of health care services and
procedures is in full swing in the United States consumer driven health
care movement. Since deregulation of the airlines with the Reagan
administration Americans have increasingly become global travelers and
consumers, so why not health care services as well? This article
explores the private sector health care population that is seeking
health care outside of the United States and examines some quality
issues.
Previously Americans seeking health care overseas were expatriates working offshore, residents with family ties in other
countries with westernized medical services, or the wealthy. Since 2000,
there has been a tremendous increase in middleclass Americans seeking
medical services abroad. Approximately twenty billion dollars annually
are spent by U.S. residents who obtain medical care off shore. The
primary medical services accessed outside of the U.S.A. purview are
cosmetic surgery, orthopedic repairs, cardiac procedures, organ
transplants, and fertility treatments. These are also high profit
services for medical facilities in the United States. Insurance
companies, largely at the behest of privately insured employers, are
including coverage for medical procedures provided off shore at an
increasing rate in their contracts. Even the nonprofit hospital group,
Christus Health in the Southwest purchased a hospital in Mexico, in
order to offer lower cost procedures within their network. This triad of
insurance companies, employer groups, and USA health care providers has
created a tsunami of change in the provision of health care.
In 2003, I conducted research on medical tourism for Seattle Cancer Care
Alliance and Fred Hutchison Cancer Research Center, for a marketing
project to encourage transplant patients to obtain care in Seattle. At
that time, no thought was given to patients seeking transplant
procedures outside the United States for the exportation of medical
care. My survey included facilities on the east and west coasts. Though I
was very enthusiastic about the potential for business development for
world class transplant centers, this was not shared by my direct
reports. I recall how a Miami Florida facility had a very advanced
patient support system, including housing, interpretation, and other
assimilation services. How things have changed in a mere seven years,
now United States transplant facilities must compete with international
facilities who are obtaining Joint Commission International
accreditation, and can offer the same services as U.S. health centers
for less than half of what the same services would cost in the states,
inclusive of travel expenses!
The next step to assuring a safe process for adventurous or maybe even frugal patients, who seek medical
care outside U.S. oversight, is to identify quality indicators on a
global scale, and incorporate quality measures into certification, and
contracting of services throughout the globe. India and Thailand both
have international centers that cater to western patients and other
countries are rapidly developing their ability to serve global patients.
For any medical procedure involving surgery, infection is one of the risks,
and is a frequent complication post-op. Infection rates by procedure
and facility should be tracked and reported in a transparent manner for a
primary quality indicator. A second indicator would of course be
mortality, incidence of death, again, by procedure and facility. A third
quality indicator would be the re-admission rate for complications from
a procedure, which could include complications from co morbidities and
device or surgical failure rates. Another quality indicator would be
certification of facilities and clinical staffers. A part of this
certification should include the frequency with which they perform the
contracted procedures and their patient success and failure rates.
Meaning, surgeries that go as planned as well as those with unintended
consequences, including death. Cost or value should also be included in
the scorecard for determining an international medical center’s
performance. Administrative functioning and efficiency should also be
considered in contracting for quality with an international facility.
Finally, the patient’s experience should also be included in a
facility’s quality assessment. These seven criteria provide a good basis
to create a quality benchmark from which to gauge an off shore
healthcare facility’s excellence prior to contracting for services.
Though all of these criteria are important in attempting to pre-qualify an
international medical facility’s ability to perform as contracted, the
patient’s health status and mobility are also essential elements of any
surgical intervention. Insurance companies, who incorporate medical
tourism into their contracts, should require a U.S. physician to examine
each patient’s ability to seek services at a non-local facility. If the
patient may be certified as healthy enough to seek services off shore,
then the insurer would approve the procedure. Also, U.S. physicians are
reluctant to release patients to clinicians they do not know and
facilities for which they are unfamiliar. Insurance companies and health
care providers should find ways to build confidence between
professionals as needed. I won’t address the legal implications of off
shore medical services, but I am sure it is just a question of time
before a malpractice or wrongful death suit is filed under medical
tourism.
This article was written by Roberta Winter, MHA, MPA, President of Praevalere Inc., a Seattle based health care consulting
firm, and may be reprinted with her permission.